Factors associated with low adherence to cervical cancer follow-up retest among HPV+/ cytology negative women: a study in programmatic context in a low-income population in Argentina

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Background Cervical Cancer is still a major public health challenge in low and middle-income countries. HPV testing has been an innovative approach, which was introduced in Argentina for women aged 30+ through the Jujuy Demonstration Project (JDP) carried out between 2012 and 2014. After a positive...

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Autores principales: Arrossi, Silvina, Paolino, Melisa, Gago, Juan
Formato: Artículo
Lenguaje:Inglés
Publicado: 1471-2407 2019
Materias:
HPV
Neoplasias del Cuello Uterino
Cumplimiento y Adherencia al Tratamiento
Acceso en línea:http://repositorio.cedes.org/handle/123456789/4507
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6480915/
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Respositorio Digital CRIS del CEDES - Centro de Estudios de Estado y Sociedad de Centro de Estudios de Estado y Sociedad (CEDES)
id I61-R167-123456789-4507
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spelling I61-R167-123456789-45072025-03-30T22:59:55Z Factors associated with low adherence to cervical cancer follow-up retest among HPV+/ cytology negative women: a study in programmatic context in a low-income population in Argentina Arrossi, Silvina Paolino, Melisa Gago, Juan HPV Neoplasias del Cuello Uterino Cumplimiento y Adherencia al Tratamiento Background Cervical Cancer is still a major public health challenge in low and middle-income countries. HPV testing has been an innovative approach, which was introduced in Argentina for women aged 30+ through the Jujuy Demonstration Project (JDP) carried out between 2012 and 2014. After a positive HPV-test, cytology is used as triage method. Under this protocol, the group of women with HPV+ and normal cytology are recommended to repeat the test within 12–18 months. Studies have shown that this group has increased risk of CIN2+, however, assuring high levels of repeating test among these women is difficult to achieve. We analyze those factors associated with lower re-test attendance among HPV+/ cytology negative women at a programmatic level in low-middle income settings. Methods We used data of women aged 30+ HPV-tested in the JDP and followed until 2018 (n = 49,565). We performed a set of different adjusted logistic regression models. Primary outcomes were re-test attendance and re-test attendance within recommended timeframe. We assessed as covariates age, health insurance status, year of HPV-testing, Pap testing in the past 3 years, HPV-testing modality (clinician-collected (CC) tests/self-collected (SC) tests), and span between HPV-test collection and report of results. Results Forty nine thousand five hundred sixty five women were HPV-tested and 6742 had a positive HPV-test. Among HPV+ women, a total of 4522 were HPV+/Cytology negative (67.1%). In total, 3172 HPV+/Cytology negative women (70.1%) had a record of a second HPV test as of March 2018. Only 1196 women (26%) completed the second test within the timeframe. Women with no record of a previous Pap (OR: 0.46, 95% CI: 0.4–0.53, p < 0.001), aged 64+ (OR: 0.46, 95% CI: 0.31-0.68, p < 0.001) were less likely to be retested; while women with clinician-collected samples had higher odds of being re-tested (OR: 1.42, 95% CI: 1.06–1.91, p < 0.001). Conclusions Low re-test rates were found in HPV +/ normal cytology women. Tailored interventions are needed to increase the effectiveness of the screening in this group, especially for those women with characteristics associated to lower attendance. Área de Salud, Economía y Sociedad 2019-05-21T23:49:15Z 2019-05-21T23:49:15Z 2019-04-23 Artículo http://repositorio.cedes.org/handle/123456789/4507 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6480915/ 1471-2407 1 367 19 10.1186/s12885-019-5583-7 31014287 en application/pdf 1471-2407
institution Centro de Estudios de Estado y Sociedad (CEDES)
institution_str I-61
repository_str R-167
collection Respositorio Digital CRIS del CEDES - Centro de Estudios de Estado y Sociedad
language Inglés
topic HPV
Neoplasias del Cuello Uterino
Cumplimiento y Adherencia al Tratamiento
spellingShingle HPV
Neoplasias del Cuello Uterino
Cumplimiento y Adherencia al Tratamiento
Arrossi, Silvina
Paolino, Melisa
Gago, Juan
Factors associated with low adherence to cervical cancer follow-up retest among HPV+/ cytology negative women: a study in programmatic context in a low-income population in Argentina
topic_facet HPV
Neoplasias del Cuello Uterino
Cumplimiento y Adherencia al Tratamiento
description Background Cervical Cancer is still a major public health challenge in low and middle-income countries. HPV testing has been an innovative approach, which was introduced in Argentina for women aged 30+ through the Jujuy Demonstration Project (JDP) carried out between 2012 and 2014. After a positive HPV-test, cytology is used as triage method. Under this protocol, the group of women with HPV+ and normal cytology are recommended to repeat the test within 12–18 months. Studies have shown that this group has increased risk of CIN2+, however, assuring high levels of repeating test among these women is difficult to achieve. We analyze those factors associated with lower re-test attendance among HPV+/ cytology negative women at a programmatic level in low-middle income settings. Methods We used data of women aged 30+ HPV-tested in the JDP and followed until 2018 (n = 49,565). We performed a set of different adjusted logistic regression models. Primary outcomes were re-test attendance and re-test attendance within recommended timeframe. We assessed as covariates age, health insurance status, year of HPV-testing, Pap testing in the past 3 years, HPV-testing modality (clinician-collected (CC) tests/self-collected (SC) tests), and span between HPV-test collection and report of results. Results Forty nine thousand five hundred sixty five women were HPV-tested and 6742 had a positive HPV-test. Among HPV+ women, a total of 4522 were HPV+/Cytology negative (67.1%). In total, 3172 HPV+/Cytology negative women (70.1%) had a record of a second HPV test as of March 2018. Only 1196 women (26%) completed the second test within the timeframe. Women with no record of a previous Pap (OR: 0.46, 95% CI: 0.4–0.53, p < 0.001), aged 64+ (OR: 0.46, 95% CI: 0.31-0.68, p < 0.001) were less likely to be retested; while women with clinician-collected samples had higher odds of being re-tested (OR: 1.42, 95% CI: 1.06–1.91, p < 0.001). Conclusions Low re-test rates were found in HPV +/ normal cytology women. Tailored interventions are needed to increase the effectiveness of the screening in this group, especially for those women with characteristics associated to lower attendance.
format Artículo
author Arrossi, Silvina
Paolino, Melisa
Gago, Juan
author_facet Arrossi, Silvina
Paolino, Melisa
Gago, Juan
author_sort Arrossi, Silvina
title Factors associated with low adherence to cervical cancer follow-up retest among HPV+/ cytology negative women: a study in programmatic context in a low-income population in Argentina
title_short Factors associated with low adherence to cervical cancer follow-up retest among HPV+/ cytology negative women: a study in programmatic context in a low-income population in Argentina
title_full Factors associated with low adherence to cervical cancer follow-up retest among HPV+/ cytology negative women: a study in programmatic context in a low-income population in Argentina
title_fullStr Factors associated with low adherence to cervical cancer follow-up retest among HPV+/ cytology negative women: a study in programmatic context in a low-income population in Argentina
title_full_unstemmed Factors associated with low adherence to cervical cancer follow-up retest among HPV+/ cytology negative women: a study in programmatic context in a low-income population in Argentina
title_sort factors associated with low adherence to cervical cancer follow-up retest among hpv+/ cytology negative women: a study in programmatic context in a low-income population in argentina
publisher 1471-2407
publishDate 2019
url http://repositorio.cedes.org/handle/123456789/4507
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6480915/
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AT gagojuan factorsassociatedwithlowadherencetocervicalcancerfollowupretestamonghpvcytologynegativewomenastudyinprogrammaticcontextinalowincomepopulationinargentina
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